HomeMy WebLinkAboutTR-E 31-18-16Board Of $outhold Town Trustees
SOUTHOLD, NEW YORK
PERMIT NO.
ISSUED TO
ul orJ alio
Pursuant to the provisions of Chapter 615 o{ the Laws of
the State of New York, 1893; and Chapter 404 of the L.aws of the
State of New York 1982; and the Soufhold Town Ordinance
titled "REGULATING AND THE PLACING OF OBSTRUCTIONS
IN AND ON TOWN WATERS AND PUBLIC LANDS and the
REMOVAL OF SAND, GRAVEL OR OTHER MATERIALS FROM
LANDS UNDER TOWN WATERS;" and in accordance with the
Resolution of The Board adopted at a meeting held on
19 , and in consideration of the sum of $ paid by
of N.Y. and subject fo the
Terms and Conditions listed on the reverse side hereof,
of Sou+hold Town Trustees authorizes and permits the following:
all in accordance with the detailed specifications as presented in
the originating appJlcafion.
IN WITNESS WHEREOF, The sai8 Board of Trustees here-
by causes its Corporate Seal to be affixed, and these presents to
be subscribed by a ma ori~y of ~'l~e said'Board~s-o~thls date.
..................................... ~.-.~[[j.;; ..............................
TRUSTEES
John M. Bredemeyer, III, President
Henry P. Smith, Vice President
Albert J. Krupski, Jr.
John L. Bednoski. Ir.
John B~ Tuthill
Telephone (516) 765-1892
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
IARRIS
Supervisor
53095 Main Road
P.O. Box 1179
11971
Fax (516) 765-1823
Telephone (516) 765~I800
GRANDFATHER APPLICATION
1. Name of Applicant:
2. Mailing address:
3. Address
Tel. No: ~3i-~o 9
of Proper~y: ~.~ ~.~o~,T~ k~._~ k'~"-~ V~o~.
Tax Map Number: 1000- 03t- ;~-l&
Prior owner if known: ~t~ ~c~
Diagram of existing structures,
included with this application:
Approx.yr.of construct: I~~'''
includinu all dimensions, must be
Indicate on attached map: Location, ie; reference point, telephone
pole number, adjacent property owners, etc.
Signature of applicant: /~~ ~c~'Date: I~/~/~,
Please note, there is a one time fee of $50.00 for filing this
application.
Consul rant _ , ~,~/~ .~-.~-~/
Project Name ./~../17/'~-~. ~ ~z'.~ ~J
Date ~ '~/-/ ~
information in ~his regard for any -~equirad return submissicn:
~, ~, r~-::~.~ . ~..f ~. ~:.1~ / ~ , ~
T~fstee Representative
cc:-~Buildi~Dep~..
.-~onin~B~a~_ of Appe~s
j~Q.~Dr~vati~ct~-~-y Council
This notice makes no claim with respect to other jurisdictions
within or outside the Town of Southold with respect to permits,
permission required.
4./92
i